Agenda item
Presentation on Health Assessments for Looked after Children
A presentation will be provided by Nikola Rickard (Lead Nurse for LAC – London North West Healthcare NHS Trust) on Health Assessments for Looked After Children.
Minutes:
Jacinth Jeffers (General Manager, Children’s Services – Brent, London North West Healthcare NHS Trust) introduced the presentation and stated that it would initially focus on three different case studies of Looked After Children (LAC) before providing an overview of the year ahead for Brent LAC and Care Leavers. She noted that the 2016-2017 LAC Annual Health Report was in the process of being ratified internally before it would be circulated more widely to relevant stakeholders.
Esther Powers (LAC Specialist Nurse) began and provided detail on the first case study which focused on a looked after child known as “Jane” who was under five years old. She gave a ‘snapshot’ of the case and explained that Jane was 11 months old having been removed from her parent’s care at birth, and that she was now on her third placement with a prospective adopter. Members heard that, although Jane was placed outside of the borough, the health assessment team had travelled to see her in order to provide a holistic assessment which not only assessed typical health elements such as height and weight, but emotional wellbeing and attachment to her new carer too. She explained the subsequent process for drawing up a health plan and how the child’s GP, school nurse, health visitor and other relevant parties would be involved. She noted that the final report and health plan would be forwarded to the Council’s social care service and that the child would have access to a copy of the plan.
Esther Powers moved onto the second case study of a boy known as “Joe” who was over five years old, and was now on his fifth placement having been removed from his parent’s care at age six. She spoke about the health assessment which had highlighted that Joe was limited in his diet, and only ate one type of food at one time. Members heard that the health assessment team worked with Joe’s GP, a dietician and his foster carer in order to understand and address the issue to allow Joe to move forward to a more normal nutritional experience. She also explained the use of a strengths and difficulties questionnaire which assisted the creation of a health plan for Joe.
The Committee heard about the final case study which focused on an unaccompanied asylum seeking child (UASC) known as “John” who was over five years old and on his first placement of care in the UK. Esther Powers explained that UASC tended to be over five years old and often required specific support such as access to English Language courses or services. She outlined John’s sexuality had caused care placement problems for him in the past and that the health plan which had been drawn aimed to address this to ensure he was well supported and comfortable. Ms Powers concluded and stressed the importance of health plans being followed to improve the young person’s experience in care and also explained that children under five years old had health assessments every six months and children over five years old had them annually.
At this point of the meeting, Members were invited to ask questions on the case studies outlined. A Member of the Committee referred to “Jane’s” case study and questioned what shape the assessments would take as the child became older. Esther Powers responded and said that the skillset of specialist LAC nurses would continue to be utilised as part of the assessments and that it remained important to monitor the child’s development holistically, such as through an evaluation of the communication and bond between the child and their carer. It was also mentioned that consideration of any transfer from fostering to adoption placements were vitally important in the long term.
A Member asked how many UASC had been assessed in the past year and what the process had been for assessments of age across both health and social care settings. Nigel Chapman (the Council’s Operational Director of Integration and Improved Outcomes) stated that 68 UASC had approached the borough for support as of 30 September 2017. He outlined that the Council had trained members of staff to undertake age assessments if young people arrived, usually at either Brent Civic Centre or local police stations, without any documentation. He detailed that if the young person was under 18 the Council would consider the best path for their care, and that if the young person was deemed over 18 they would usually be referred to the Home Office. Jacinth Jeffers said that the NHS was mandated to deliver health assessments and deliver care regardless for UASC, and as such age assessments were not a primary concern.
Jacinth Jeffers provided the second part of the presentation which provided an overview of the year ahead for Brent LAC and Care Leavers. She spoke about a focus on internal audit processes in order to drive up quality and timeliness for LAC and Care Leavers’ health assessments the methods to draw upon resources and feedback in order to continuously ensure services had been improved. She ran through some additional priorities for the upcoming year which included: the identification of all LAC teenage pregnancies and development of a health database; linking with the Local Authority Engagement Officer to attend participation meetings with LAC and Care Leavers; develop and implement health pathways for all UASCs; improve methods of sharing information across relevant multi-agency organisations; continue to provide training for foster carers and kinship carers; monitor health outcomes and actions for LAC; continue expanding the work of the outreach service; have the Lead Doctor and Nurse continue to provide training on new CoramBAAF forms, processes and outomces for LAC to social workers, trainees and nurses; and assess feasibility of rolling out an ‘NHS Go’ app which provided young people with access to all personal health information and enable them to make and receive appointments regarding their care.
A representative from CIA questioned what the provisions were for LAC with mental health issues. Jacinth Jeffers explained that a referral would be made to the relevant Child and Adolescent Mental Health Services (CAMHS) alongside a review of all of the different options available to the child.
Discussions ensued on the potential roll out of the ‘NHS Go’ app and whether this was deemed more likely to be more efficient and effective than the health passport for LAC. Jacinth Jeffers clarified to a member of the Committee that the app provided generic information on different health needs, and was essentially a supporting signpost application to relevant services. Esther Powers added that the app was designed to be friendlier to young people than the health passport, and was beneficial particularly in allowing young people to book appointments. The CIA representatives present were split in their opinions on the prospective app, and raised that the health passport remained popular. It was also mentioned that the app would require young people to have enough mobile phone data at all times in able to access. It was acknowledged that there needed to be additional dialogue between the NHS and CIA representatives present and it was suggested that a meeting be organised to discuss both the app and health passport at a date in the near future.
It was RESOLVED that the presentation be noted.